Nurse Case Manager II
Core
Managing care for members with complex and chronic care needs by assessing, developing, implementing, coordinating, monitoring, and evaluating care plans to optimize health care across the care continuum.
Role type
Licensed RN Case Manager
Builds
Care management plans and care continuum optimization
Domain
Health insurance / Chronic care management
Deliverable
production ML models | product features | dashboards & analysis | research | client delivery | infrastructure | physical/clinical work
Required skills
Clinical assessment, care plan development, authorization/referral facilitation, resource coordination, plan monitoring and evaluation, provider negotiation, policy development
Preferred skills
Case Manager certification
Technologies
Telephony
Responsibilities
Conduct assessments to identify individual needs and specific care management plans; Implement care plans by facilitating authorizations and referrals; Coordinate internal and external resources to meet identified needs; Monitor and evaluate effectiveness of care management plans; Interface with Medical Directors and Physician Advisors on treatment plans; Negotiate rates of reimbursement; Assist with development of utilization/care management policies and procedures
Seniority
Mid-level, hands-on IC